Healthcare Provider Details

I. General information

NPI: 1629729363
Provider Name (Legal Business Name): GAGREET SEKHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 BLACKHAWK ST
MISSION HILLS CA
91345-2505
US

IV. Provider business mailing address

15200 BLACKHAWK ST
MISSION HILLS CA
91345-2505
US

V. Phone/Fax

Practice location:
  • Phone: 818-359-7707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35077-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: